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Bigstone Health Benefits

Bigstone Health Benefits

Bigstone health benefits are an inherent right for registered treaty status indians as defined by the indian act and are constitutionally protected. The benefits are to be comprehensive, accessible and provided as needed in a timely manner to all registered treaty status bigstone cree nation members living on reserve and off reserve and who are ordinarily resident in canada.

The national NIHB and BHB do not pay for medically justified products and services for Treaty Status Indians residing outside of Canada.

The Bigstone Health Benefits program draws its authority from the Federal Government, the 1979 Indian Health Policy and the renewed mandate of 1997. BHB follows the national guidelines, policy, procedure and mandate. The program is needs-based which covers some of the cost for medically justified products and services that are not covered by Provincial, Territorial or any other third-party Health Plans. Bigstone Health Benefits complements Alberta Health Care benefits such as Doctor’s visits and hospital services.

The Goals and Objectives of Bigstone Health Benefits are to provide benefits to registered Bigstone Cree Nation membership in a manner that:

Is appropriate to unique health needs

Contributes to the achievement of an overall health status that is comparable to that of the Canadian population as a whole

Is sustainable from a fiscal and benefit management perspective

Will maintain health, prevent disease, facilitate early detection of disease, and management of illness, injury or disability.

The purpose of this web page is to provide Bigstone Cree Nation members with important information about the Bigstone Health Benefits program. It explains procedures in accessing products and services; who to contact, what is covered, who provides the service, how to access benefits and what your responsibilities are as a client.

All goods and services eligible under the Bigstone Health Benefits (BHB) program must receive prior approval with an attached prescription from a licensed Medical Doctor or Specialist.

Bigstone Health Benefits Contact Information

ADDRESS: 16310 100 Ave Edmonton, Alberta, Canada T5P4x5

PHONE: 780-341-2777

FAX: 780-444-6521

TOLL FREE: 1-866-891-9719

VISION CARE OPTICAL

EXTENSION 4001

DIRECT LINE: 780-341-2780

Monday - Friday 8:00AM to 5:00PM

DENTAL

EXTENSION 4000

DIRECT LINE: 780-481-4261

Monday - Friday 8:00AM to 5:00PM

PHARMACY AND MEDICAL SUPPLIES

EXTENSION 4023

DIRECT LINE: 780-341-2776

Monday - Friday 8:00AM to 7:00PM

MENTAL HEALTH

EXTENSION 4021

DIRECT LINE: 780-341-2783

Monday - Friday 8:30AM to 4:30PM

BHB SUPERVISOR

EXTENSION 4021

DIRECT LINE: 780-341-2783

What is covered?

VISION

Eye exams: routine

Every 2 years for ages 19 to 64.

Diabetic clients: major annual eye exam

Replacement eye glasses/lenses

Every 24 months for a person 18 years old and over.

Every 12 months for a person younger than 18 years.

Replacement lenses within the 24 month period if there is a significant change in vision.

Repairs

The total cost of the repair must not be more than it would cost to replace with standard frames.

One major and one minor within the eyeglasses replacement time frame (12 or 24 months).

DENTAL

Diagnostic services (exams & x-rays)

Preventive services (cleanings)

Restorative services (fillings)

Endodontic services (root canals)

Periodontal services (deep cleanings)

Prosthodontic services (removable dentures)

Oral surgery services (extractions, removal of teeth)

Adjunctive services(general anesthetic, sedation)

Orthodontic services (braces)

Dental services covered under the bigstone health benefits program are divided into two (2) schedules;

Schedule a – these are categories of dental services that do not require predetermination but may have frequency limitations.

Schedule b – these are categories of dental services that require predetermination.

Remember – the rules about what is covered may vary by region depending upon provincial/territorial insured services.

PHARMACY

Prescription medications

Over-the-counter medications

Injectable drugs including injectable allergy serums

Extemporaneous mixtures (compounded medications)

Drug delivery devices, as required, to deliver medications

Recognized non-oral contraceptive devices

Therapeutic vitamins and minerals

Special formularies for; Clients with chronic renal failure, Clients who are diagnosed with a terminal illness and are near the end of life and For Adjunct Medications Used During Active Cancer Treatment

The NIHB drug benefit list consists of 5 different sections:

Open benefit drug – these drugs are a benefit without having to issue prior approval.

Limited use benefits – these drugs have been found effective in specific circumstances therefore, will have to go through a process before being approved.

Palliative care – clients diagnosed with a terminal illness and are near the end of life will be eligible to receive coverage for a list of supplemental benefits. These medications are used to provide comfort to those near the end of life.

Every 12 months, an eligible client can receive up to 22 hours of counselling performed by an enrolled provider on a fee-for-service basis .

The Benefit is intended to provide coverage for the immediate psychological and emotional care to individuals in significant distress to stabilize their condition, minimize potential trauma from an acute life event, and, as appropriate, transition them to other mental health supports.